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MUSKULOSKELETAL DISORDERS

Submitted by:
Jho Ann Labor
BSN- IV
Submitted to:
Mrs. Dapnhny Hatud
Arthritis

Degenerative Joint Disease


Arthritis= joint inflammation.
Arthralgia= joint pain
Different types of arthritis:
- Osteoarthritis
- Rheumatoid arthritis
- Gouty arthritis
Osteoarthritis

Most common form of arthritis, noninflammatory, nonsystemic disease


One or many joints undergo degenerative and progressive changes, mainly wt. bearing
joints.
Stiffness, tenderness, crepitus and enlargement develop.
Deformity, incomplete dislocation and synovial effusion may eventually occur.
Treatment: rest, heat, ice, anti-inflammatory drugs, decrease wt. if indicated, injectable
corticosteroids, surgery.
Risk Factors

Age
Decreased muscle strength
Obesity
Possible genetic risk
Early in disease process, OA is difficult to dx from RA
Hx of Trauma to joint
Signs and Symptoms

Joint pain and stiffness that resolves with rest or inactivity


Pain with joint palpation or ROJM
Crepitus in one or more joints
Enlarged joints
Heberdens nodes enlarged at distal IP joints
Bouchards nodes located at proximal IP joints
What to assess for:

ESR, X-rays, CT scans


Pain
Degree of functional limitation
Levels of pain/fatigue after activity
Range of motion
Proper function/joint alignment
Home barriers and ability to perform ADLs
Treatment

Pharmacotherapy- tylenol, NSAIDS, ASA, Cox-2 inhibitors


Intra-articular injections of corticosteroids
Glucosamine- acts as a lubricant and shock absorbing fluid in joint, helps rebuild
cartilage
Balance rest with activity
Use bracing or splints
Apply thermal therapies
Arthroplasty- joint replacement can relieve pain and restore loss of function for patients
with advanced disease.
Auto-Immune Disease

Inflammatory and immune response are normally helpful


BUT these responses can fail to recognize self-cells and attack normal body tissues.
Called an auto-immune response
Can severely damage cells, tissues and organs
EG. RA, SLE, Progressive systemic sclerosis, connective tissue disorders and other organ
specific disorders
Rheumatoid Arthritis

Chronic, systemic, progressive inflammatory disease of the synovial tissue, bilateral,


involving numerous joints.
Synovitis-warm, red, swollen joints resulting from accumulation of fluid and
inflammatory cells.
Classified as autoimmune process
Exacerbations and remissions
Can cause severe deformities that restrict function
Risk Factors

Female gender
Age 20-50 years
Genetic predisposition
Epstein Barr virus
Stress
Diagnostic Test

Rheumatoid Factor antibody- High titers correlate with severe disease, 80% pts.
Antinuclear Antibody (ANA) Titer- positive titer is associated with RA.
C- reactive protein- 90% pts.
ESR: Elevated, moderate to severe elevation
Arthocentesis- synovial fluid aspirated by needle
Signs and Symptoms

Joints- bilateral and symmetric stiffness, tenderness, swelling and temp. Changes in
joint.
Pain at rest and with movement
Pulses- check peripheral pulses, use Doppler if necessary, check capillary refill.
Edema- observe, report and record amt. and location of edema.
ROM, muscle strength, mobility, atrophy
Anorexia, weight loss
Fever- generally low grade
Treatment

Rest, during day- decrease wt. bearing stress.


ROM- maintain joint function, exercise water.
Medication- analgesic and anti-inflammatory (NSAIDS), steroids, Gold therapy, topical
meds. Immunosuppressive drugs- Imuran, Cytoxan, and methotrexate. Monitor for
toxic effects
Biological response modifiers (BRM):Inhibit action of tumor necrosis factor (Humira,
Enbrel, Remicade)
Ultrasound, diathermy, hot and cold applications
Surgical- Synovectomy, Arthroplasty, Total hip replacement.
Nursing Interventions

Assist with/encourage physical activity


Provide a safe environment
Utilize progressive muscle relaxation
Refer to support groups
Emotional support
Complications

Sjogrenss syndrome
Joint deformity
Vasculitis
Cervical subluxation

Gouty Arthritis
- Very painful joint inflammation, swollen and reddened
Primary -Inborn error of uric acid metabolism- increases production and interferes with
excretion of uric acid
Secondary - Hyperuricemia caused by another disease
Excess uric acid converted to sodium urate crystals and precipitate from blood and become
deposited in joints- tophi or in kidneys, renal calculi
Treatment:

Meds- colchicine, NSAIDS, Indocin (indomethacin), glucocorticoid drugs,


Allopurinol, Probenecid-reduce uric acid levels
Diet- excludes purine rich foods, such as organ meats, anchovies, sardines, lentils,
sweetbreads, red wine
Avoid ASA and diuretics- may precipitate attacks

Osteoporosis
- Metabolic bone disorder- progressively porous, brittle, fragile bones, low bone
density, susceptible to fractures
- Occurs in postmenopausal women
- Bone resorption (osteoclast) > bone formation (osteoblast) activity
- Dowagers hump progressive kyphosis gradual collapse of vertebrae.
- Post-menopausal lose height, c/o fatigue.
Diagnostic tests:

Radiographs,
Dexa scans
Risk Factors

Gerontologic- over 80 yrs. old, 84% have osteoporosis.


Family hx, thin, lean body build
Postmenopausal estrogen deficiency
Hyperparathyroidism increases bone resorption
Hx of low Ca intake and low levels of Vit D
Long term corticosteroid use
Lack of physical activity/ prolonged immobility
Hx of smoking, high alcohol intake

Pt. teaching- osteoporosis

Adequate dietary calcium- 1200mg/day with fluids


Exercise, wt. bearing beneficial.
Walking outdoors- vitamin D absorption.
Good body mechanics
Safe home environment, fall prevention
Balanced diet- protein, Mg, Vit K & D, Ca
Modify lifestyle choices- smoking, alcohol and caffeine intake and sedentary lifestyle.
Medication

HRT-Raloxifene (Evista)
PTH- Forteo Subcut
Bisphosphonates- Fosamax,Boniva, Actonal
Reclast, Zometia
Calcitonin, Vit D
NSAIDs

Osteomyelitis
- Infection of the bone
Endogenous:
- Extension of soft tissue infection- infected pressure ulcers or incision.
- Blood borne (spread from other body sites)
- At risk- poorly nourished, elderly, obese, impaired immune systems, corticosteroid
therapy, and chronic illnesses.
- Prevention- proper tx. of infections, aseptic post op wound care
Exogenous:
- Organism enters from outside the body. Eg. Open fx
Signs and symptoms

High fever, chills, increased HR, general malaise, swelling, tenderness, heat and
erythema, painful movement.
Draining ulcers, bone pain
Diagnostic result:

increased WBCs
elevated ESR
positive blood cultures
X-rays
bone scan
MRI
Treatment

Long term IV antibiotics


Hickman or other CVAD catheter
Strict sterile technique for tx
Hyperbaric oxygen tx
Surgery- bone exposed and necrotic tissue removed, debridement, bone grafts,
amputation

Contusions, Strains, Sprains


- Contusion-soft tissue injury, hematoma, ecchymosis.
- Strain - muscle pull over use over stretching.
- Sprain an injury to ligaments surrounding joint, caused by twisting.
Management - RICE
Rest
Ice
Compression
Elevation.
Fractures

Complete- a break across the entire cross- section and is frequently displaced.
Incomplete (Greenstick)-break occurs through only part of the cross-section of the
bone.
Closed Fracture (simple) - doesnt break through the skin.
Open fracture (compound) - extends through the skin
Comminuted- splintered into fragments
Depressed- fragment(s) is(are) in driven

Signs and Symptoms

Pain- continuous and increases in severity after injury.


Swelling- usually over affected area, but can also occur in adjacent structures.
Reduction- open or closed
Treatment

Casting and/or traction


Complications
Shock
Fat embolism
Compartment syndrome
DVT, thromboembolism or pulmonary embolism.
DIC
Infection
Avascular necrosis

Hip fractures
- High incidence in elderly due to risk for falls, osteoporosis.
- Intracapsular- Neck of femur, may damage blood supply, aseptic necrosis.
- Extracapsular- base of neck and lesser trochanter of femur- heals more easily.
- ORIF- open reduction with internal fixation.
Symptoms of Fractures

Deformity
Swelling
Bruising
Muscle spasms
Tenderness
Pain

Impaired sensation
Loss of normal function
Abnormal mobility
Crepitus
Shock
Abnormal X-rays

Nursing Diagnoses

Risk for injury r/t subluxation or dislocation


Pain related to surgical incision
Risk for infection r/t impaired skin integrity
Impaired physical mobility
Risk for Peripheral Neurovascular Dysfunction

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